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Turek D, Haefliger S, Ameline B, Alborelli I, Calgua B, Hartmann W, Harder D, Flanagan AM, Amary F, Baumhoer D. Brown Tumors Belong to the Spectrum of KRAS -driven Neoplasms. Am J Surg Pathol 2022; 46:1577-1582. [PMID: 36040039 PMCID: PMC9561227 DOI: 10.1097/pas.0000000000001963] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Brown tumors are rare and generally self-limiting mass lesions of bone occurring in the context of hyperparathyroidism. Although commonly regarded as endocrine-driven tumor-like lesions, we detected pathogenic hotspot KRAS mutations in 10/16 brown tumors (62%) with similar frequencies found in cases affecting the peripheral and axial skeleton. Pathogenic mutations in other driver genes of the RAS-MAPK pathway were not identified. Our findings suggest brown tumors to represent true neoplasms driven by the activation of the RAS-MAPK signaling pathway. The frequent regression of brown tumors after normalization of hyperparathyroidism points to a second hit mediated by endocrine stimulation to be required for tumor development. Our findings underline the pathogenic relation of brown tumors to nonossifying fibroma and giant cell granuloma of the jaws which both appear histologically similar to brown tumors and are also driven by RAS-MAPK signaling pathway activation.
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Affiliation(s)
- Daniel Turek
- Bone Tumor Reference Centre, Institute of Medical Genetics and Pathology
| | - Simon Haefliger
- Bone Tumor Reference Centre, Institute of Medical Genetics and Pathology
| | - Baptiste Ameline
- Bone Tumor Reference Centre, Institute of Medical Genetics and Pathology
| | | | | | - Wolfgang Hartmann
- Division of Translational Pathology, Gerhard-Domagk-Institut of Pathology, University Hospital Münster, Münster, Germany
| | - Dorothee Harder
- Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Adrienne M. Flanagan
- Cellular and Molecular Pathology, Royal National Orthopaedic Hospital, Stanmore, Greater London
- Research Department of Pathology, University College London, UCL Cancer Institute, London, UK
| | - Fernanda Amary
- Cellular and Molecular Pathology, Royal National Orthopaedic Hospital, Stanmore, Greater London
- Research Department of Pathology, University College London, UCL Cancer Institute, London, UK
| | - Daniel Baumhoer
- Bone Tumor Reference Centre, Institute of Medical Genetics and Pathology
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Abstract
ABSTRACT A 50-year-old man presented with right chest pain and persistent increased parathyroid hormone after parathyroidectomy for parathyroid carcinoma. 68Ga-DOTATATE PET/CT and 18F-FDG PET/CT were performed consecutively for restaging to determine subsequent treatment strategy. An osteolytic lesion on the right sixth rib showed increased uptake on both 68Ga-DOTATATE and 18F-FDG PET/CT. Subsequent biopsy confirmed it to be a brown tumor.
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Affiliation(s)
- Xilan Yao
- From the Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
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3
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Massive Exophytic Brown's Tumor of the Bilateral Maxilla with Mandibular Involvement. J Craniofac Surg 2021; 33:897-900. [PMID: 34690307 DOI: 10.1097/scs.0000000000008308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
ABSTRACT Brown's tumor is a benign bone lesion that occurs in the setting of hyperparathyroidism and can affect the facial skeleton. It often presents as a single lesion and is usually less than 3 centimeters. To our knowledge, no cases have been reported to have bilateral involvement of the maxilla and mandible with the largest dimension measuring over 7 centimeters. This report describes such a case and provides a review of the literature.
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4
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Bransky N, Iyer NR, Cannon SM, Tyan AH, Mylavarapu P, Orosco R, Hom DB, Moazzam AA. Three Rare Concurrent Complications of Tertiary Hyperparathyroidism: Maxillary Brown Tumor, Uremic Leontiasis Ossea, and Hungry Bone Syndrome. J Bone Metab 2020; 27:217-226. [PMID: 32911586 PMCID: PMC7571245 DOI: 10.11005/jbm.2020.27.3.217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/02/2020] [Indexed: 12/27/2022] Open
Abstract
A 48-year-old woman in her 40’s with end-stage renal disease and tertiary hyperparathyroidism (HPT) presented for a rapidly progressive maxillary tumor. Initial workup was notable for elevated intact parathyroid hormone (PTH) and diffuse thickening of skull and facial bones on computed tomography, and maxillary tumor biopsy with multinucleated giant cells. She underwent subtotal parathyroidectomy (with removal of a parathyroid adenoma and 2 hyperplastic glands) and partial resection of maxillary brown tumor. The patient’s post-operative course was complicated by hungry bone syndrome, with hypocalcemia refractory to aggressive calcium repletion. Teriparatide (recombinant PTH) was utilized with rapid resolution of hypocalcemia. To our knowledge, this is the first case of maxillary brown tumor in tertiary HPT to be reported in the USA. This case also supports teriparatide as a novel therapeutic for hungry bone syndrome refractory to aggressive calcium repletion.
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Affiliation(s)
- Natalie Bransky
- Division of Hospital Medicine, UC San Diego Medical Center, San Diego, CA, USA
| | - Neena Ramesh Iyer
- Division of Hospital Medicine, UC San Diego Medical Center, San Diego, CA, USA
| | | | | | - Praneet Mylavarapu
- Division of Hospital Medicine, UC San Diego Medical Center, San Diego, CA, USA
| | - Ryan Orosco
- Division of Hospital Medicine, UC San Diego Medical Center, San Diego, CA, USA
| | - David Brain Hom
- Division of Hospital Medicine, UC San Diego Medical Center, San Diego, CA, USA
| | - Alan Ali Moazzam
- Division of Hospital Medicine, UC San Diego Medical Center, San Diego, CA, USA
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Kumar Yadav A, Pawar E, Harsoor A, Kumar G S P, Rohra H. Primary hyperparathyroidism with extensive brown tumours and distal humerus fracture-A case report. Int J Surg Case Rep 2020; 66:421-424. [PMID: 31991305 PMCID: PMC6994264 DOI: 10.1016/j.ijscr.2019.12.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 11/24/2019] [Accepted: 12/30/2019] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION A brown tumour is benign bony lesion caused by localized, rapid osteoclastic turnover, resulting from hyperparathyroidism. In this report, we present a case of 25-year-old woman with multiple swelling and bone pain. Plain radiographs of the affected bones revealed multiple erosive bone tumours, which were diagnosed as brown tumours associated with primary hyperparathyroidism. CASE REPORT A 25 year old female presented with swelling in left elbow since 1 month along with multiple swelling in body. Patient had pain in left elbow after trivial fall. X-ray showed lytic lesion of left elbow with pathological fracture. Biopsy was suggestive of brown tumour of distal humerus. DISCUSSION We managed this case with reconstruction of defect with fibula grafting and plating. CONCLUSION Pathological fracture in young adult should always be properly investigated. A high index of suspicion is necessary to diagnose unusual presentation of Primary Hyperparathyroidism.
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Affiliation(s)
- Amit Kumar Yadav
- Grant Medical College & Sir JJ Group of Hospitals Mumbai, India.
| | - Eknath Pawar
- Grant Medical College & Sir JJ Group of Hospitals Mumbai, India
| | - Abhishek Harsoor
- Grant Medical College & Sir JJ Group of Hospitals Mumbai, India.
| | | | - Hitesh Rohra
- Grant Medical College & Sir JJ Group of Hospitals Mumbai, India.
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Gnathic Bones and Hyperparathyroidism: A Review on the Metabolic Bony Changes Affecting the Mandible and Maxilla in case of Hyperparathyroidism. Adv Med 2020; 2020:6836123. [PMID: 32695835 PMCID: PMC7368230 DOI: 10.1155/2020/6836123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 06/05/2020] [Accepted: 06/22/2020] [Indexed: 11/17/2022] Open
Abstract
Parathyroid glands secrete the parathyroid hormone that plays an essential role in bone remodeling. Excessive production of parathyroid hormone causes a common metabolic bone disorder known as hyperparathyroidism that is classified into primary, secondary, or tertiary. In hyperparathyroidism, the late bony complication is manifested as a giant cell osteolytic lesion called "brown tumor." Primary hyperparathyroidism is usually a sporadic disorder, but in minority of cases it occurs in inherited forms, and one of these forms is the hyperparathyroidism-jaw tumor syndrome, which is characterized by primary hyperparathyroidism and ossifying fibroma in the mandible and/or maxilla.
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7
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Xu W, Qu Y, Shi W, Ma B, Jiang H, Wang Y, Qu N, Zhu Y. Multiple bone brown tumor secondary to primary hyperparathyroidism: a case report and literature review. Gland Surg 2019; 8:810-816. [PMID: 32042691 DOI: 10.21037/gs.2019.11.14] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Bone brown tumors secondary to primary hyperparathyroidism (PHPT) are rare and only around 2-5% of PHPT patients have multiple bone brown tumor lesions, which are also uncommon in literatures. We found a female patient who got misdiagnosis of multiple malignant bone tumors in our clinical work, she was eventually diagnosed as a brown tumor secondary to hyperparathyroidism. This article records the diagnosis and treatment process, and summarizes similar case reports in the past decade to provide experience in diagnosis and treatment of similar cases that may occur in the future.
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Affiliation(s)
- Weibo Xu
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Yanqing Qu
- Department of Thyroid Surgery, Yantaishan Hospital, Yantai 264001, China
| | - Wen Shi
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Ben Ma
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Hongyi Jiang
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Yu Wang
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Ning Qu
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Yongxue Zhu
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
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8
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Abdulla S, Shamil E, Wilsher M, Jacob A. Atypical presentation of oncocytic parathyroid adenoma masquerading as metastatic carcinoma. BMJ Case Rep 2019; 12:12/9/e231373. [PMID: 31492732 DOI: 10.1136/bcr-2019-231373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Parathyroid carcinoma is the rarest endocrine malignancy. Definitive diagnosis is challenging as it is difficult to distinguish malignant from benign disease. A 71-year-old man presented with weight loss and hypercalcaemia. CT scans revealed multiple lung nodules and lytic bone lesions that were consistent with metastatic dissemination. Technetium-99m-sestamibi-single-photon emission computed tomography scan showed an abnormal uptake in the right thyroid lobe. Fine-needle aspiration (FNA) was performed on three occasions. The patient underwent parathyroidectomy with ipsilateral hemithyroidectomy without postoperative complications. Microscopic examination showed a parathyroid neoplasm with fibrosis and intravascular tumour on a background of unremarkable thyroid parenchyma. This resulted in an initial impression of parathyroid carcinoma. Further review by two independent pathologists provided a final diagnosis of oncocytic parathyroid adenoma. This case highlights the subjectivity and interobserver variation with endocrine histological examination. FNA can induce changes that mimic parathyroid carcinoma on histology. An index of suspicion for benign parathyroid adenomas should be maintained.
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Affiliation(s)
- Suha Abdulla
- School of Medical Education, King's College London, London, UK
| | - Eamon Shamil
- Department of ENT Surgery, University Hospital Lewisham, London, UK
| | - Mark Wilsher
- Department of Pathology, University Hospital Lewisham, London, UK
| | - Antony Jacob
- Department of ENT Surgery, University Hospital Lewisham, London, UK
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9
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Singhal AA, Baijal SS, Sarin D, Pathak A. Unusually Large Brown tumor of Mandible in a Case of Secondary Hyperparathyroidism Mimicking Cherubism. Indian J Nucl Med 2018; 33:132-135. [PMID: 29643674 PMCID: PMC5883431 DOI: 10.4103/ijnm.ijnm_145_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We report here a case of unusually large brown tumor of mandible mimicking cherubism in a patient with secondary hyperparathyroidism (HPT). The patient is a young male with a large head and a protruding jaw with an open mouth appearance. Initial clinical appearance looked like cherubism. However further clinical, biochemical, and radiological evaluation revealed a large brown tumor in a case of prolonged secondary HPT, which was confirmed on histopathology. All of the typical advanced radiological features of HPT were noted, highlighting the severity of progression of the disease. This case emphasizes the need for surveillance of serum calcium levels on routine biochemical investigations as to enable an early diagnosis of HPT. With timely proper management, such cases should be on the decline in the future.
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Affiliation(s)
- Alka Ashmita Singhal
- Medanta Division of Radiology and Nuclear Medicine, Medanta The Medicity Hospital, Gurugram, Delhi, NCR, India
| | - Sanjay Saran Baijal
- Medanta Division of Radiology and Nuclear Medicine, Medanta The Medicity Hospital, Gurugram, Delhi, NCR, India
| | - Deepak Sarin
- Medanta Division of Radiology and Nuclear Medicine, Medanta The Medicity Hospital, Gurugram, Delhi, NCR, India
| | - Atul Pathak
- Medanta Division of Radiology and Nuclear Medicine, Medanta The Medicity Hospital, Gurugram, Delhi, NCR, India
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10
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Systematic review of oral manifestations related to hyperparathyroidism. Clin Oral Investig 2017; 22:1-27. [DOI: 10.1007/s00784-017-2124-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 05/10/2017] [Indexed: 12/29/2022]
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11
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Wémeau JL, Cardot-Bauters C. [Maxillary, buccal and dental expressions of hyperparathyroidisms]. Presse Med 2017; 46:845-852. [PMID: 28579010 DOI: 10.1016/j.lpm.2017.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 04/11/2017] [Accepted: 05/02/2017] [Indexed: 12/24/2022] Open
Abstract
States of chronic parathyroid hypersecretion, related to a primitive parathyroid abnormality (adenoma, hyperplasia), or to a cause of chronic calcipenia (renal failure, vitamin D deficiency…) have a major impact on bone remodeling, alveolodental structures. Thinning of the lamina dura, maxillary or mandibular brown tumors, giant cell epulis are the most emblematic signs of the primary hyperparathyroidism. Other expressions are related to genetic factors such as fibrous tumors of the jaw in conjunction with mutations in the gene coding for parafibromin.
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12
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Krishna Mohan VS, Narayan ML, Mukka A, Bachimanchi B, Chowhan AK, Devi BV, Vaikkakara S, Sachan A. Atypical Parathyroid Adenoma with Multiple Brown Tumors as Initial Presentation: A Rare Entity. Indian J Nucl Med 2017; 32:133-136. [PMID: 28533644 PMCID: PMC5439188 DOI: 10.4103/0972-3919.202234] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Brown tumors seen in hyperparathyroidism are rare, non-neoplastic lesions because of abnormal bone metabolism, and they can mimic benign bone tumors or malignancy. Although biopsy is considered as the gold standard for diagnosis, it can be inconclusive. As the diagnosis of brown tumors is often challenging, a high index of suspicion is essential for diagnosis. We present a case of 21-year-old woman who presented with multiple painful bony lesions, which were initially misdiagnosed as fibrous dysplasia. Due to persistent bone pain and deterioration in her physical mobility, she was referred to tertiary care centre. After thorough clinical workup, she underwent Tc-99m methylene diphosphonate bone scintigraphy that raised strong clinical suspicion of hyperparathyroidism and brown tumors. Subsequently, Tc-99m-methoxy isobutyl isonitrile (MIBI) parathyroid scintigraphy revealed a solitary MIBI avid focal lesion, suggestive of left inferior parathyroid adenoma. Later parathyroidectomy was performed and histopathological examination confirmed it as atypical parathyroid adenoma.
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Affiliation(s)
- V S Krishna Mohan
- Department of Nuclear Medicine and PET CT, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Manishi L Narayan
- Department of Nuclear Medicine and PET CT, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Arun Mukka
- Department of Endocrinology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Bharath Bachimanchi
- Department of Endocrinology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Amit Kumar Chowhan
- Department of Pathology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - B Vijayalakshmi Devi
- Department of Radiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Suresh Vaikkakara
- Department of Endocrinology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Alok Sachan
- Department of Endocrinology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
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Choi JH, Kim KJ, Lee YJ, Kim SH, Kim SG, Jung KY, Choi DS, Kim NH. Primary Hyperparathyroidism with Extensive Brown Tumors and Multiple Fractures in a 20-Year-Old Woman. Endocrinol Metab (Seoul) 2015; 30:614-9. [PMID: 26354493 PMCID: PMC4722419 DOI: 10.3803/enm.2015.30.4.614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 04/06/2015] [Accepted: 04/27/2015] [Indexed: 11/27/2022] Open
Abstract
A brown tumor is a benign fibrotic, erosive bony lesion caused by localized, rapid osteoclastic turnover, resulting from hyperparathyroidism. Although brown tumors are one of the most pathognomonic signs of primary hyperparathyroidism, they are rarely seen in clinical practice. In this report, we present a case of 20-year-old woman with recurrent fractures and bone pain. Plain digital radiographs of the affected bones revealed multiple erosive bone tumors, which were finally diagnosed as brown tumors associated with primary hyperparathyroidism due to a parathyroid adenoma. This case shows that multiple, and clinically severe form of brown tumors can even occur in young patients.
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Affiliation(s)
- Ju Hee Choi
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Kyoung Jin Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Ye Jin Lee
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Sun Hwa Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Sin Gon Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Kwang Yoon Jung
- Department of Otolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Dong Seop Choi
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Nam Hoon Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
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Oliveira FMD, Makimoto TE, Scalissi NM, Marone MMS, Maeda SS. Regression of orbital brown tumor after surgical removal of parathyroid adenoma. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2015; 59:455-9. [PMID: 26331231 DOI: 10.1590/2359-3997000000088] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 12/01/2014] [Indexed: 11/22/2022]
Abstract
Brown tumors are rare skeletal manifestations that occur in less than 2% of primary hyperparathyroidism (PHPT) cases. Even rarer is the occurrence of brown tumor of the orbit, and few cases have been reported around the world. The rare instance of this benign tumor has prompted us to report the case and treatment of an orbital brown tumor in a patient with PHPT caused by parathyroid adenoma. We present the case of a patient undergoing follow-up at a referral center. The 60-year-old female patient, presented herself with progressive swelling in the nasal region, epistaxis and proptosis, she had noticed seven months prior to our examination. Multiple imaging and laboratory findings revealed parathyroid hormone (PTH)-dependent hypercalcemia (total calcium = 14.3 mg/dL and PTH = 1,573 pg/mL), a nodular lesion in the upper pole of the left thyroid lobe and increased uptake in left upper cervical region. The patient underwent left superior parathyroidectomy in September 2011, which led to the normalization of hypercalcemia and regression of the orbital tumor, as seen on control CT scan. This case highlights the spontaneous regression of the brown tumor after surgical management of the parathyroid adenoma.
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Affiliation(s)
| | - Tiago Eidy Makimoto
- Departamento de Medicina, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
| | - Nilza Maria Scalissi
- Departamento de Medicina, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
| | | | - Sergio Setsuo Maeda
- Departamento de Medicina, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
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15
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Mandibular Brown Tumor of Secondary Hyperparathyroidism Requiring Extensive Resection: A Forgotten Entity in the Developed World? Case Rep Med 2015; 2015:567543. [PMID: 26413096 PMCID: PMC4556817 DOI: 10.1155/2015/567543] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Accepted: 08/05/2015] [Indexed: 12/22/2022] Open
Abstract
Brown tumor of hyperparathyroidism (BTHPT) is rare in the United States and not frequently seen in clinical practice. This is likely because early diagnosis and prompt treatment of this disease process prevent the progression and development of BTHPT. Conversely, BTHPT is more common in underdeveloped countries where fewer patients have access to health care and hyperparathyroidism (HPT) goes untreated. It has been reported that the incidence of BTHPT in underdeveloped countries can be as high as 58 to 69 percent in patients with primary HPT. We present a case report of a patient in the United States with a large mandibular BTHPT requiring an extensive resection in the setting of secondary HPT. Despite being rare in this country, it is important for nephrologists, primary care physicians, and oral health care providers to be able to recognize this entity, so that intervention may be rendered early.
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16
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Marchiori ÉC, Isom BA, Indresano AT. Management of Ossifying Fibroma in a Suspicious Case of Hyperparathyroid-Jaw Tumor Syndrome. Craniomaxillofac Trauma Reconstr 2014; 8:228-33. [PMID: 26269732 DOI: 10.1055/s-0034-1395381] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 01/26/2014] [Indexed: 10/24/2022] Open
Abstract
The purpose of this article is to report a case of ossifying fibroma in the mandible associated with hyperparathyroid-jaw tumor syndrome, in a 46-year-old Caucasian female, surgically resected and reconstructed with iliac crest bone, followed by implant placement. This is a rare syndrome with an autosomal dominant pattern, with the development of primary hyperparathyroidism mainly due to parathyroid adenomas. Fibro-osseous lesions in the jaws can be present and can also precede the development of the endocrine disorder. As renal abnormalities and uterine tumors can develop, an interdisciplinary approach is imperative for its diagnosis and management, due to the possibility of recurrence and potential for malignancy.
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Affiliation(s)
- Érica Cristina Marchiori
- Department of Oral and Maxillofacial Surgery, University of the Pacific-San Francisco, Alameda County Medical Center Highland General Hospital, Oakland, California
| | - Blair Alexander Isom
- Department of Oral and Maxillofacial Surgery, University of the Pacific-San Francisco, Alameda County Medical Center Highland General Hospital, Oakland, California
| | - Albert Thomas Indresano
- Department of Oral and Maxillofacial Surgery, University of the Pacific-San Francisco, Alameda County Medical Center Highland General Hospital, Oakland, California
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Qari FA. Brown tumor in a patient with ectopic mediastinal parathyroid adenoma: A case report. Saudi Dent J 2014; 26:74-7. [PMID: 25408600 DOI: 10.1016/j.sdentj.2013.12.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 12/07/2013] [Accepted: 12/24/2013] [Indexed: 11/16/2022] Open
Abstract
Brown tumors are uncommon focal giant-cell lesions that arise as a direct result of the effect of parathyroid hormone on bone tissue in some patients that have hyperparathyroidism. Primary hyperparathyroidism could be caused by ectopic mediastinal parathyroid adenomas. The occurrence of lesions is explainable on embryologic basis. We present a 55-year-old Saudi woman with a rare case of brown tumor of the maxilla due to ectopic mediastinal parathyroid adenoma.
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Affiliation(s)
- Faiza A Qari
- Department of Endocrinology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
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